ObjectiveTo investigate the role of endoplasmic reticulum stress in liver regeneration after associating liver partition and portal vein ligation for staged hepatectomy (ALPPS).MethodsSeventy-two C57bl/6 mice were randomly divided into ALPPS group, portal vein ligation group (PVL group), and sham operation group (Sham group), 24 mice in each group. And then one-stage ALPPS operation, simple PVL, and sham operation will be performed. Six mice were randomized selected of the three groups on the 1st, 2nd, 4th, and 7th day after surgery, respectively, the liver weight to body weight ratio (FLR/BW) of each group was measured, and the liver tissues were taken for immunohistochemical staining to calculate the proportion of Ki-67 positive cells, Western blot was used to detect the expression levels of X-box binding protein 1 (XBP1) and inositol-requiring enzyme 1α (IRE1α) proteins.Results① FLR/BW: On the 4th day and the 7th day after operation, the FLR/BW of the Sham group, PVL group, and ALPPS group increased in sequence at the same time, and the difference between the three groups was statistically significant (P<0.05). ② Ki-67 positive cell ratio: On the 2nd day after operation, the ratio of Ki-67 positive cells in the Sham group, PVL group, and ALPPS group increased sequentially, and the difference between the two groups was statistically significant (P<0.05). On the 4th day after operation, the ratio of Ki-67 positive cells in the PVL group and the ALPPS group were still higher than that of the Sham group (P<0.05). ③ Expression levels of XBP1 and IRE1α: On the 2nd and 4th postoperative day, the expression levels of XBP1 and IRE1α in the ALPPS group were higher than those in the Sham group and the PVL group (P<0.05). On the 7th day after surgery, the expression levels of XBP1 and IRE1α in the ALPPS group were higher than those in the Sham group (P<0.05), while compared with the PVL group, the expression level of XBP1 in the ALPPS group was still higher (P<0.05).ConclusionsALPPS-induced liver regeneration is more advantageous than traditional PVL in mice. It may be attributed to the obvious endoplasmic reticulum stress activation after ALPPS leading to the up-regulation of IRE1α-XBP1 expression, which is involved in the regulation of hepatocyte cell cycle and promotes hepatocyte proliferation, thus promoting rapid liver regeneration.
Objective To compare the effectiveness of intramedullary nailing fixation via suprapatellar approach and medial parapatellar approach in semi-extended position in the treatment of multiple tibial fractures.Methods The clinical data of 43 patients with multiple tibial fractures treated with intramedullary nailing fixation between July 2018 and December 2022 were retrospectively analyzed, including 23 patients treated with suprapatellar approach in semi-extended position (group A) and 20 patients with medial parapatellar approach in semi-extended position (group B). There was no significant difference in gender, age, cause of injury, time from injury to operation, AO/Orthopaedic Trauma Association (AO/OTA) classification, preoperative visual analogue scale (VAS) score, and range of motion (ROM) of the knee joint between the two groups (P>0.05). The operation time, intraoperative blood loss, incision length, intraoperative fluoroscopy frequency, and fracture healing time were recorded and compared. The VAS score and ROM of the knee joint were analyzed at 4, 8, and 12 weeks after operation, and the incidence of postoperative complications was observed; knee function was evaluated by Lysholm score at last follow-up. ResultsThe operations were successfully completed in both groups, and there was no complication such as nerve and blood vessel injury during operation, and all incisions healed by first intention. There was no significant difference in operation time, intraoperative blood loss, and intraoperative fluoroscopy frequency between the two groups (P>0.05), but the incision length in group B was significantly longer than that in group A (P<0.05). Patients in both groups were followed up 12-30 months, with an average of 21.1 months. The VAS score decreased and ROM increased gradually in both groups with time after operation, showing significant differences between different time points (P<0.05). The VAS score of group B was significantly lower than that of group A at 4 and 8 weeks after operation (P<0.05); there was no significant difference in VAS score and ROM between the two groups at other time points (P>0.05). There was no significant difference in fracture healing time between the two groups (P>0.05). During the follow-up, there was no complication such as internal fixator loosening, breakage, and loss of fracture reduction. At last follow-up, the Lysholm score in group B was significantly better than that in group A (P<0.05). Conclusion Both the suprapatellar approach and the medial parapatellar approach in semi-extended position can achieve satisfactory results in the treatment of multiple tibial fractures. The medial parapatellar approach has lower symptoms of early knee pain and better long-term function.
Objective To investigate the current status and development of electronic health records (EHR) at home and abroad to grasp the development trends of EHR, so as to point out the direction of the development and relevant research on EHR. Methods Based on the Web of Science citation database and the principle of bibliometrics, we analyzed the retrieved literature in aspects of publication date, language, country/region, institution, author, etc. Results A total of 1 262 eligible studies were identified. The number of articles on EHR increased rapidly from only 2 in 1995 to 218 in 2012. In terms of country/region, the United States ranked the top in all countries (763 articles, accounting for 60.46%). In terms of institution, Harvard University ranked the top (135 articles, accounting for 10.70%). In terms of journal, the Journal of the American Medical Informatics Association ranked the top (106 articles, accounting for 8.40%). In terms of authors, David W. Bates ranked the top (45 articles, accounting for 3.57%). In terms of subject type, health care sciences services and medical informatics were mainly focused on. Conclusion The research on EHR has become a global hot spot and relevant bibliometrics will contribute to the timely and correctly grasp the whole picture of its development trends and main research direction.
Objective To prepare a spider silk protein bilayer small diameter vascular scaffold using electrospinning, and to observe the blood compatibility in vitro. Methods The Arg-Gly-Asp-recombinant spider silk protein (pNSR16), polycaprolactone (PCL), gelatin (Gt), and heparin (Hep) were blended. Spider silk protein bilayer small diameter vascular scaffold (experimental group) was prepared by electrospinning, with pNSR16 ∶ PCL ∶ Hep (5 ∶ 85 ∶ 10, W/W) hybrid electrospun solution as inner spinning solution and pNSR16 ∶ PCL ∶ Gt (5 ∶ 85 ∶ 10, W/W) hybrid electrospun solution as outer spinning solution, but pNSR16 ∶ PCL (5 ∶ 85, W/W) hybrid electrospun solution was used as inner spinning solution in control group. The scaffold structure of experimental group was observed under scanning electron microscope (SEM); and the hemolysis rate, recalcification clotting time, dynamic clotting time, platelet adhesion, and platelet activation in vitro were compared between 2 groups. Results SEM results showed that bilayer fibers of scaffold were quite different in experimental group; the diameter distribution of inner layer fibers was relatively uniform with small pores, however diameter difference of the outer layer fiber was relatively big with big pores. The contact angle, hemolysis rate, recalcification clotting time, and P-selectin expression of scaffold were (35 ± 3) ° , 1.2% ± 0.1%, (340 ± 11) s, and 0.412 ± 0.027 respectively in experimental group, and were (70 ± 4) ° , 1.9% ± 0.1%, (260 ± 16) s, and 0.678 ± 0.031 respectively in control group; significant difference were found in indexes between 2 groups (P lt; 0.05). With the extension of time, the curve of coagulation time in experimental group sloped downward slowly and had a long time; the blood clotting index values before 30 minutes were significantly higher than those in control group (P lt; 0.05). Platelet adhesion test showed that the scaffold surface almost had no platelet adhesion in experimental group. Conclusion The spider silk protein bilayer small diameter vascular scaffold could be prepared through electrospinning, and it has good blood compatibility in vitro.
【Abstract】 Objective To evaluate the mid-term effectiveness of Oxford Unicompartmental Knee system Phase III for medial unicompartmental knee osteoarthritis (OA). Methods Between December 2008 and August 2010, 26 patients (32 knees) with medial unicompartmental knee OA were treated. Of 26 patients, 11 were followed up more than 2 years, including 7 males and 4 females (14 knees, 6 left and 8 right knees) with an average age of 62.4 years (range, 50-74 years). All patients had load suffering and tenderness of medial unicompartmental knee, and complicated by varus deformity without limitation of flexion and extension; the disease duration ranged 5-23 years (mean, 11.6 years). According to Ahlback staging, 4 knees were at stage II and 10 knees at stage III. Cemented unicompartmental knee arthroplasty (Oxford Unicompartmental Knee system Phase III) was performed by minimally invasive technique. Results All the incisions were primary healing after operation. Five cases suffered from local ache in the pes anserinus during the first 3 months after operation, which was cured after conservative therapy. Of them, 11 patients were followed up 27.5 months on average (range, 24-30 months). During follow-up, no complication of prosthesis loosening, displacement, arthropathy in the opposite department, or the patellofemoral joint occurred. The range of motion was significantly improved from (109.2 ± 8.7)° preoperatively to (123.5 ± 6.7)° at last follow-up (P lt; 0.05); knee society score (KSS) and Western Ontario and McMaster University Osteoarthritis Index (WOMAC) scores were all significantly improved (P lt; 0.05). At last follow-up, the femoro-tibial angle was significantly improved (P lt; 0.05); tibial plateau and the tibial anatomical axis increased, showing no significant difference (P gt; 0.05); and posterior tibial slope was significantly decreased (P lt; 0.05). Conclusion Oxford Unicompartmental Knee system Phase III has satisfactory mid-term effectiveness in treating medial unicompartmental knee OA with the advantages of little trauma and rapid recovery, but long-term effectiveness is expected for further follow-up.
Objective To explore effects of macrophage migration inhibitory factor (MIF) inhibitor ISO-1 on intestinal injury in acute necrotic pancreatitis in pregnancy (ANPIP) rat. Methods Twenty-four pregnant SD rats were randomly averagely divided into three groups: a sham operation (SO) group, an ANP group, and an ANP model plus ISO-1 treatment group (ISO-1 group). A rat model of ANP was induced by the retrograde injection of 5% sodium taurocholate into the biliopancreatic duct. The rats were killed and the inferior vena cava blood and the tissues of pancreas and jejunum were harvested at 12 h after the operation. The serum amylase (AMY), lipase (LIP), diamine oxidase (DAO), interleukin (IL)-1β, and IL-6 levels were measured. The pancreatic and jejunal tissues were taken for the pathological examination scoring. The immunohistochemical method was used to detect the expression of the MIF, nuclear factor (NK)-κB, or tumor necrosis factor (TNF)-α protein. Results ① Compared with the SO group, the serum AMY, LIP, DAO, IL-1β, and IL-6 levels were increased in the ANP group (P<0.050), which in the ISO-1 group were decreased as compared with the ANP group, the DAO, IL-1β, and IL-6 levels had significant differences (P<0.050), but the AMY and LIP levels had no significant differences (P>0.050). ② The pathological points of the pancreas and jejunum tissues were increased in the ANP group as compared with the SO group, which were significantly decreased in the ISO-1 group as compared with the ANP group (P<0.050). ③ The average integrated optical density divide by area of the NF-κB,TNF-α, and MIF were significantly increased in the ANP group as compared with the SO group, which were significantly decreased in the ISO-1 group as compared with the ANPgroup (P<0.050). Conclusions MIF inhibitor ISO-1 could protect intestinal injury in ANPIP rat. It is suggested that MIF is one of mechanisms in ANPIP with intestinal injury and might be correlated with activities of TNF-α and NF-κB.
Objective To investigate the protective effect of castanospermine (CS) on renal injury induced by severe acute pancreatitis (SAP) in rats and its possible mechanism. Methods Twenty-four SPF adult male Sprague Dawley rats were randomly divided into three groups: shame operation group (SO group, n=8), SAP group (n=8), and CS group (n=8). SAP models were induced by retrograde injection of 5% sodium taurocholate (1 mL/kg) in biliopancreatic duct in the SAP group and the CS group. CS solution (200 mg/kg) was immediately administered via intraperitoneal injection after the induction of pancreatitis in the CS group. Rats in the SO group were subjected to a sham surgery that the pancreas and duodenum were flipped a number of times. All rats were sacrificed at 12 h after modeling. Blood samples were collected by inferior vena cava puncture, and serum activities of amylase (AMY), levels of blood urea nitrogen (BUN) and creatinine (Cr) were measured by using a fully automatic chemistry analyzer. The head of pancreas and renal tissues were harvested and pathological change was observed under the light microscope. Expressions of nuclear factor-κB (NF-κB), tumor necrosis factor-α (TNF-α), intercellular adhesion molecule-1 (ICAM-1), and Caspase-3 in renal tissues were evaluated by immunohistochemistry assay. Results ① Compared with the SO group, the damages of the pancreas and kidney tissues were significantly worse in the SAP group, and the above damages in the CS group were significantly decreased when comparing with the SAP group. ② Compared with the SO group, the serum activities of AMY, levels of BUN and Cr were significantly increased in the SAP group (P<0.05). The serum activities of AMY, levels of BUN and Cr in the CS group were significantly lower than those of the SAP group (P<0.05). ③ Compared with the SO group, the integrated optical density (IOD) of NF-κB, TNF-α, ICAM-1, and Caspase-3 in renal tissues were significantly increased in the SAP group (P<0.05), and the above indicators in kidney tissues of the CS group were significantly decreased when comparing with the SAP group (P<0.05). Conclusions CS can mitigate severe acute pancreatitis-induced renal injuries in rats, it ameliorates renal injury and improves renal function. The mechanism for the above improvements is that CS can widely inhibit the activation of NF-κB, and then downregulate the expressions of TNF-α, ICAM-1, and Caspase-3.
ObjectiveTo analyze the effectiveness of fast track protocol of geriatric intertrochanteric fracture on operative waiting time, operation time, perioperative blood loss, providing data support for clinical therapy.MethodsThe clinical data of 240 elderly patients with intertrochanteric fracture admitted between January 2015 and December 2018 were retrospectively analyzed. They were divided into traditional protocol group (148 cases, group A) and fast track group (92 cases, group B). All patients were treated with closed reduction intramedullary nail (proximal femoral nail antirotation) surgery. There was no significant difference in gender, age, sides, fracture classification, fracture type, complications, the proportion of patients with more than 3 kinds of medical diseases, and the time from injury to admission between the two groups (P>0.05). Analysis index included operative waiting time (hospitalization to operation time), operation time, percentage of operation performing in 48 and 72 hours, percentage of transfusion, changes of hematocrit (Hct) at different stage (admission, operation day, and postoperative 1, 3 days), blood loss by fracture and cephalomedullary nail, intraoperative dominant blood loss, total blood loss in perioperative period were recorded and compared.ResultsThe operative waiting time, operation time, Hct on operation day and postoperative 3 days, blood loss by fracture, transfusion volume, and total blood loss in perioperative period in group B were significantly less than those in group A (P<0.05), and the percentage of operation performing in 48 and 72 hours in group B were significantly higher than those in group A (P<0.05). There was no signifcant difference in Hct on admission and postoperative 1 day, intraoperative dominant blood loss, percentage of transfusion, blood loss by cephalomedullary nail between the two groups (P>0.05).ConclusionFast track can shorten the operative waiting time of geriatric intertrochanteric fracture, reduce the blood loss by fracture, total blood loss in perioperative period, and transfusion volume. Early operation is conducive to improve the anemia status of patients during perioperative period.
ObjectiveTo investigate the protective effect of exogenous insulin on relative adrenal insufficiency (RAI) in rats with severe acute pancreatitis (SAP).MethodsEighty SPF SD rats were randomly divided into 5 groups (n=16): sham operation (SO) group, SAP group, low-dose insulin intervention (low-dose) group (0.05 U/100 g body weight), medium-dose insulin intervention (medium-dose) group (0.1 U/100 g body weight), and high-dose insulin intervention (high-dose) group (0.2 U/100 g body weight). The five groups were randomly divided into two subgroups: cosyntropin stimulation test (CST) subgroup and non-CST subgroup. SAP model was established by retrograde injection of 5% sodium taurocholate into biliopancreatic duct. The rats were sacrificed 3 hours after the establishment of SAP model. The levels of amylase (AMY), alanine aminotransferase (ALT), aspartate aminotransferase (AST), urea (Ur) and creatinine (Cr) were detected by automatic biochemical analyzer. The serum levels of tumor necrosis factor-α (TNF-α) and corticosterone (Cor) were detected by ELISA kit. The pathological changes of pancreas and adrenal gland were observed under light microscope. The lipid content of adrenal gland was observed by oil red O staining.ResultsCompared with the SO group, the serum levels of Amy, ALT, AST, Ur, Cr, TNF-α and Cor in the SAP group were significantly increased (P<0.05), typical pathological damages occurred in pancreas and adrenal gland, and pathological scores were significantly increased (P<0.05). Compared with the SAP group, the levels of AMY, ALT, AST, Ur, Cr, TNF-α and Cor in the low-dose group were not significantly changed (P>0.05); the levels of AMY, ALT, AST, Ur, Cr and TNF-α in the medium-dose group and the high-dose group were significantly decreased (P<0.05), and Cor levels were significantly increased (P<0.05). Compared with the low-dose group, AMY, ALT, AST, Cr, TNF-α in the medium-dose group and the high-dose group were significantly decreased (P<0.05), Cor level were significantly increased (P<0.05), Ur level had no significant change. There were no significant difference in AMY, ALT, AST, Ur, Cr, TNF-α and Cor levels between the medium-dose group and the high-dose group (P>0.05). After CST intervention, there were no significant change in serum Cor levels in the SAP group and the low-dose group (P>0.05), but the serum Cor levels in the SO group, the medium-dose group and the high-dose group were significantly increased (P<0.05).ConclusionAppropriate dose of exogenous insulin can improve SAP related adrenal injury and RAI, but the specific mechanism still needs further study.
Objective To investigate the application and effectiveness of metatarsal mortise and tenon shortening osteotomy in the treatment of macrodactyly in children. Methods The clinical data of 17 children with macrodactyly (18 feet and 27 toes) admitted between January 2018 and January 2020 were retrospectively analyzed. There were 12 males (12 feet and 18 toes) and 5 females (6 feet and 9 toes); the age ranged from 1 to 13 years, with a median age of 5 years. All children were treated with metatarsal mortise and tenon shortening osteotomy. Ten cases of single-segment metatarsals were shortened, 7 cases of 2-segment metatarsals, and 1 case of 3-segment metatarsals; involved 1 foot of single toe, 9 feet of 2 toes, 3 feet of 3 toes, 3 feet of 4 toes, and 2 feet of 5 toes. Five cases had lameness, and 1 case had limited walking with the big toes of both feet, and there was no obvious pain in all children. X-ray films showed that the involved phalanges were thickened and increased in 18 feet, and the deformity of the distal segment was heavier than that of the proximal segment in 13 feet, and the two were similar in 5 feet. The length of metatarsal shortening was 0.7-2.5 cm, with an average of 1.2 cm. The clinical healing of shortened metatarsal fractures in children was observed after operation, and the occurrence of related complications was recorded. ResultsAll 17 children were followed up 6-22 months, with an average of 14 months. All incisions healed by first intention. The osteotomy ends of 27 toes were clinically healed after operation, and the healing time was 4-8 weeks. No nonunion, fracture displacement, malunion, epiphyseal plate premature closure, and needle tract infection occurred. ConclusionMetatarsal mortise and tenon shortening osteotomy is a good osteotomy method. It can improve the stability of the osteotomy end and increase the contact surface of the osteotomy end, which is conducive to the healing of the osteotomy end and is suitable for the treatment of macrodactyly.